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Role of the School Nurse in Medication Administration

The administration of medications in schools, including over-the-counter (OTC)

medications, i
a nursing activity that must be under the control of a registered professional nurse and/or
licensed practical nurse. A registered nurse may delegate, train and supervise the
of medication by unlicensed personnel who are qualified by education, knowledge and
skill to
administer medication. A registered nurse shall provide and document the requisite
training and competency verification.

It is the responsibility of the registered professional nurse to:

1. Document the training, education, competency verification and supervision of

personnel who are delegated medication administration. A registered nurse may delega
the training of unlicensed personnel to licensed practical nurses who have demonstrated
the competency to provide such training. The nurse must periodically monitor
medication administration procedures of those trained by the nurse and licensed practic
nurse; See Missouri State Board of Nursing Position Statement, Manual for School

Health Programs, Appendix C.4.

2. Provide product information, safe dosage limits, side effects, drug interactions, adverse
reactions, emergency procedures, and other pertinent drug information as indicated.

3. Ensure medications originate from an order from an authorized prescriber and are
appropriate, labeled, administered as prescribed and documented appropriately.

4. Provide for safe, appropriate storage of medication.

5. Monitor the use of OTC medications and discourage the use of medication that might
mask health problems, or send the wrong message to students regarding drug use.

6. Communicate to the parent/guardian and/or authorized prescriber the effect of the

medication on the student’s performance and behavior, and apprise them of frequent
requests for medication that has been prescribed “as needed.”

7. Establish procedure to document any situations where the medication is not given as
prescribed, i.e., refusal, vomiting, spilled, or lost.

8. Establish a written procedure for dealing with questionable medication orders/requests,

including herbal preparations and OTC medications, and the manner in which refusal to
give medication due to a concern for the safety of the student is handled. The nurse has
right to refuse to administer any medication the nurse believes is not in the best interest
of the student, due to dosage, side effects or other concerns. This issue of nurse refusal
should be covered in Board-approved policy. This situation may require the
development of a 504 Accommodation Plan if the parent/guardian requests the
medication still be administered in school.

(The Missouri School Boards Association has a sample medication policy that may be
for individual district policy development.)